Latest marijuana and MS published research

[Drillerdou]

I try to keep an open mind when it comes to thc/cbd. I'm not a user, but not opposed to it either. My dr doesn't think it would help me. Maybe I'm being too critical but I hone in on the cognitive dysfunction, and the depression. These both scream NO.
It hasn't helped that since legalizing here - it seems like so many that never previously imbibed are now obsessed with pot and they are acting like college kids trying their first beer.

[ActiveMSers]

Discontinuing cannabis improves depression in people with multiple sclerosis: A short report

Show all authors
Anthony Feinstein, Cecilia Meza, Cristiana Stefan, ...

First Published June 26, 2020

https://doi.org/10.1177/1352458520934070

Abstract

To assess whether symptoms of depression change when people with multiple sclerosis (pwMS) discontinue cannabis use, 40 cognitively impaired pwMS who smoked cannabis almost daily were randomly assigned to either a cannabis continuation (CC) or cannabis withdrawal (CW) group. Both groups were followed for 28 days.

All participants completed the Hospital Anxiety and Depression Scale. At day 28 the 11-nor-9-carboxy-Δ⁹-tetrahydro-cannabinol (THCCOOH)/creatinine ratio in the CW group declined to zero (p = 0.0001), but remained unchanged in the CC group (p = 0.709). Depression scores in those pwMS who were using cannabis to manage their depression remained statistically unchanged in the CC group, but declined in the CW group (p = 0.006).

Despite pwMS using cannabis to help their mood, depression improved significantly off the drug. Our finding provides a cautionary note in relation to cannabis use in pwMS, at least with respect to depression.

[AMFADVENTURES]

Also interesting, the authors apparently do not consider "significant cognitive disfunction" a serious side effect but since essentially all drugs have side effects, it does come down to what the user considers too serious to warrant symptom relief.

[Suebee]

Interesting, I thought it was just CBD that helped MS spasticity and pain...this article suggests it works in combo with the THC. Article also opines it is better to start with this treatment over baclofen and tizadine, which have significant negative side effects. Nevertheless, this finding is of no use to me or other MSers with pain and spasticity in states where medical marijuana it is illegal. Maybe the fact that it is a synthetic drug that can be regulated (and measured dose) will lead to it being legally allowed to all in the future. Sigh. Idk, why is baclofen ok to be prescribed over salivex??? Baclofen gave me relief but i did not like.. it made me rubbery and would kick my butt with a strong rebound effect. So I just suffer. So glad another treatment may be on horizon.

[ActiveMSers]

Molecules
2020 Oct 25;25(21):E4930.
A Critical Review of the Role of the Cannabinoid Compounds Δ ⁹-Tetrahydrocannabinol (Δ ⁹-THC) and Cannabidiol (CBD) and their Combination in Multiple Sclerosis Treatment

Éamon Jones ¹, Styliani Vlachou ¹
Affiliations expand

• PMID: 33113776
• DOI: 10.3390/molecules25214930

Abstract

Many people with MS (pwMS) use unregulated cannabis or cannabis products to treat the symptoms associated with the disease. In line with this, Sativex, a synthetic combination of cannabidiol (CBD) and Δ⁹-tetrahydrocannabinol (Δ⁹-THC) has been approved to treat symptoms of spasticity. In animals, CBD is effective in reducing the amounts of T-cell infiltrates in the spinal cord, suggesting CBD has anti-inflammatory properties. By doing this, CBD has shown to delay symptom onset in animal models of multiple sclerosis and slow disease progression. Importantly, combinations of CBD and Δ⁹-THC appear more effective in treating animal models of multiple sclerosis. While CBD reduces the amounts of cell infiltrates in the spinal cord, Δ⁹-THC reduces scores of spasticity. In human studies, the results are less encouraging and conflict with the findings in animals.

Drugs which deliver a combination of Δ⁹-THC and CBD in a 1:1 ratio appear to be only moderately effective in reducing spasticity scores, but appear to be almost as effective as current front-line treatments and cause less severe side effects than other treatments, such as baclofen (a GABA-B receptor agonist) and tizanidine (an α2 adrenergic receptor agonist). The findings of the studies reviewed suggest that cannabinoids may help treat neuropathic pain in pwMS as an add-on therapy to already established pain treatments. It is important to note that treatment with cannabinoid compounds may cause significant cognitive dysfunction. Long term double-blind placebo studies are greatly needed to further our understanding of the role of cannabinoids in multiple sclerosis treatment.

[ActiveMSers]

ACTRIMS 2020 POSTER SESSION

P0439 - Cannabis Use Among People with MS: A 2020 NARCOMS Survey (ID 1483)

Speakers

• A. Salter

Authors

• A. Salter
• R. Ann Marie
• G. Cutter
• J. Steinerman
• K. Smith

Presentation Number
P0439
Presentation Topic
Epidemiology

• Abstract

Background
The North American Research Committee on Multiple Sclerosis (NARCOMS) registry is a voluntary self-report registry for persons with MS. Interest has been growing over time regarding the benefits of cannabis for management of various symptoms in MS, particularly as cannabis becomes more accessible.

Objectives
To evaluate the contemporary prevalence of cannabis use among persons with MS, and demographic factors associated with cannabis use for MS symptom management.

Methods
Active US NARCOMS participants were invited to complete an online, supplemental survey regarding cannabis use (excluding hemp CBD and products labeled as CBD only) for their MS symptoms. Demographic and clinical characteristics captured included age, sex, race, state of residence, age at MS symptom onset, and disability level measured using the Patient Determined Disease Steps (PDDS). Participant-reported symptoms of spasticity, pain, and sleep problems were captured using a numeric rating scale (NRS) with scores ranging from 0 (no problems) to 10 (worst possible problems). For the analysis we categorized NRS scores as 0 (normal), 1-3 (mild), 4–6 (moderate), and 7–10 (severe). We summarized the findings using descriptive statistics.

Results
Of the 6934 participants invited, 3249 (46.9%) responded. Most respondents were female (78.5%), Caucasian (88.5%), and had a mean (SD) age of 61.2 (10.2) years. The respondents had a mean age at symptom onset of 31.2 (10.3) years, and a median (25^th, 75^th) PDDS level of 3 [Gait Disability] (1 [Mild Disability], 6 [Bilateral Support]). Over 60% of respondents reported moderate to severe spasticity, pain, or sleep problems. Thirty-one percent of respondents (n=1012) indicated they had used cannabis for their MS symptoms at least once; of these respondents, 50.5% had used cannabis to treat spasticity, 43.6% had used cannabis for pain, and 38.4% had used cannabis for sleep. There were 636 (19.6%) respondents who reported current use of cannabis for their MS, while 376 (11.6%) reported past use but not current use. Current users were comparable to past users except current users were more likely to be male (p=0.001) and on average slightly younger (p=0.009).

Conclusions
In this US registry-based sample, 31% of participants reported ever using cannabis for MS symptoms, and 20% reported current use within the prior 30 days.

[ActiveMSers]

Original Article
Published: 25 April 2020

Effects of THC/CBD oromucosal spray on spasticity-related symptoms in people with multiple sclerosis: results from a retrospective multicenter study

Francesco Patti, Clara Grazia Chisari, […]on behalf of the SA.FE. group
Neurological Sciences (2020)

Abstract

Introduction
The approval of 9-δ-tetrahydocannabinol (THC)+cannabidiol (CBD) oromucosal spray (Sativex®) in Italy as an add-on medication for the management of moderate to severe spasticity in multiple sclerosis (MS) has provided a new opportunity for MS patients with drug-resistant spasticity. We aimed to investigate the improvement of MS spasticity-related symptoms in a large cohort of patients with moderate to severe spasticity in daily clinical practice.

Materials and methods
MS patients with drug-resistant spasticity were recruited from 30 Italian MS centers. All patients were eligible for THC:CBD treatment according to the approved label: ≥ 18 years of age, at least moderate spasticity (MS spasticity numerical rating scale [NRS] score ≥ 4) and not responding to the common antispastic drugs. Patients were evaluated at baseline (T0) and after 4 weeks of treatment (T1) with the spasticity NRS scale and were also asked about meaningful improvements in 6 key spasticity-related symptoms.

Results
Out of 1615 enrolled patients, 1432 reached the end of the first month trial period (T1). Of these, 1010 patients (70.5%) reached a ≥ 20% NRS score reduction compared with baseline (initial responders; IR). We found that 627 (43.8% of 1432) patients showed an improvement in at least one spasticity-related symptom (SRSr group), 543 (86.6%) of them belonging to the IR group and 84 (13.4%) to the spasticity NRS non-responders group.

Conclusion
Our study confirmed that the therapeutic benefit of cannabinoids may extend beyond spasticity, improving spasticity-related symptoms even in non-NRS responder patients.

[loopylady]

Brain Behav Immun. 2019 Jul 26. pii: S0889-1591(19)30647-6. doi: 10.1016/j.bbi.2019.07.028. [Epub ahead of print]

Combination of cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), mitigates experimental autoimmune encephalomyelitis (EAE) by altering the gut microbiome.

Al-Ghezi, et al

Abstract

Currently, a combination of marijuana cannabinoids including delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is used as a drug to treat muscle spasticity in patients with Multiple Sclerosis (MS). Because these cannabinoids can also suppress inflammation, it is unclear whether such patients benefit from suppression of neuroinflammation and if so, what is the mechanism through which cannabinoids act.

In the currently study, we used a murine model of MS, experimental autoimmune encephalomyelitis (EAE), to study the role of gut microbiota in the attenuation of clinical signs of paralysis and inflammation caused by cannabinoids.

THC+CBD treatment attenuated EAE and caused significant decrease in inflammatory cytokines such as IL-17 and IFN-γ while promoting the induction of anti-inflammatory cytokines such as IL-10 and TGF-β. Use of 16S rRNA sequencing on bacterial DNA extracted from the gut revealed that EAE mice showed high abundance of mucin degrading bacterial species, such as Akkermansia muciniphila (A.muc), which was significantly reduced after THC+CBD treatment. Fecal Material Transfer (FMT) experiments confirmed that THC+CBD-mediated changes in the microbiome play a critical role in attenuating EAE. In silico computational metabolomics revealed that LPS biosynthesis, a key component in gram-negative bacteria such as A.muc, was found to be elevated in EAE mice which was confirmed by demonstrating higher levels of LPS in the brain, while treatment with THC+CBD reversed this trend. EAE mice treated with THC+CBD also had significantly higher levels of short chain fatty acids such as butyric, isovaleric, and valeric acids compared to naïve or disease controls.

Collectively, our data suggest that cannabinoids may attenuate EAE and suppress neuroinflammation by preventing microbial dysbiosis seen during EAE and promoting healthy gut microbiota.

Thanks Dave for all you do for us and the information you share with us.

[loopylady]

Toneroni

Thanks for sharing this information.

I got medical marijuana card in bakersfield for my MS and it's awesome. For me, cannabis has been extraordinarily helpful with spasticity vs prescription drugs like carbamazepine. Honestly, they had me on quite a few different anti-spasticity drugs, but that is the only one I recall at the moment. I find smoking it to be my favorite because the effects are immediate, and you can control you doses better. I’ve had success with both THC and CBD. I usually aim for a strain which is 3-5% THC and 9-15% CBD. I also make CBD coconut oil to add to tea or other things. If you have specific questions I have answers! Not that I`m an expert by any means! I’ve just had to do a lot of research on it.

thanks for sharing. I've wondered many times if I should check into this but it concerns me because I don't really want to feel "high". My brother, God rest his soul, had Parkinson's and Crohn's...he would have taken it any way he could get it.

[toneroni]

Thanks for sharing this information.

I got medical marijuana card in bakersfield for my MS and it's awesome. For me, cannabis has been extraordinarily helpful with spasticity vs prescription drugs like carbamazepine. Honestly, they had me on quite a few different anti-spasticity drugs, but that is the only one I recall at the moment. I find smoking it to be my favorite because the effects are immediate, and you can control you doses better. I’ve had success with both THC and CBD. I usually aim for a strain which is 3-5% THC and 9-15% CBD. I also make CBD coconut oil to add to tea or other things. If you have specific questions I have answers! Not that I`m an expert by any means! I’ve just had to do a lot of research on it.

[Suebee]

I echo Goathearder. Because it is illegal under federal law (and the minority of states) it is a treatment that may cause a MSer greater legal woes than symptomatic relief. This isn't to say it is not hugely beneficial to manage some MS symptoms, it just is not an option for all.
Uht

[GoatHerder]

Not For Me

My last neurologist kept pushing that for my symptoms, but I declined strongly.

Because THC is still illegal under federal law, I have no desire to lose my second amendment rights to own and carry a firearm, for a few less symptoms (if it even worked for me!)

[ActiveMSers]

Brain Behav Immun. 2019 Jul 26. pii: S0889-1591(19)30647-6. doi: 10.1016/j.bbi.2019.07.028. [Epub ahead of print]

Combination of cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), mitigates experimental autoimmune encephalomyelitis (EAE) by altering the gut microbiome.

Al-Ghezi, et al

Abstract

Currently, a combination of marijuana cannabinoids including delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) is used as a drug to treat muscle spasticity in patients with Multiple Sclerosis (MS). Because these cannabinoids can also suppress inflammation, it is unclear whether such patients benefit from suppression of neuroinflammation and if so, what is the mechanism through which cannabinoids act.

In the currently study, we used a murine model of MS, experimental autoimmune encephalomyelitis (EAE), to study the role of gut microbiota in the attenuation of clinical signs of paralysis and inflammation caused by cannabinoids.

THC+CBD treatment attenuated EAE and caused significant decrease in inflammatory cytokines such as IL-17 and IFN-γ while promoting the induction of anti-inflammatory cytokines such as IL-10 and TGF-β. Use of 16S rRNA sequencing on bacterial DNA extracted from the gut revealed that EAE mice showed high abundance of mucin degrading bacterial species, such as Akkermansia muciniphila (A.muc), which was significantly reduced after THC+CBD treatment. Fecal Material Transfer (FMT) experiments confirmed that THC+CBD-mediated changes in the microbiome play a critical role in attenuating EAE. In silico computational metabolomics revealed that LPS biosynthesis, a key component in gram-negative bacteria such as A.muc, was found to be elevated in EAE mice which was confirmed by demonstrating higher levels of LPS in the brain, while treatment with THC+CBD reversed this trend. EAE mice treated with THC+CBD also had significantly higher levels of short chain fatty acids such as butyric, isovaleric, and valeric acids compared to naïve or disease controls.

Collectively, our data suggest that cannabinoids may attenuate EAE and suppress neuroinflammation by preventing microbial dysbiosis seen during EAE and promoting healthy gut microbiota.

[ActiveMSers]

Cannabis Use in People with Multiple Sclerosis and Self-Reported Spasticity

Cinda Hugos1,2, Jessica Rice1,2, Michelle Cameron1,2
1 Portland VA Health Care System
2 Oregon Health & Science University

Objective:
To describe cannabis use in subjects with MS and spasticity.

Background:
Spasticity affects over 80% of people with MS, impacting activity, participation and quality of life. 2014 AAN systematic reviews found pharmaceutical cannabinoids (oral or oral-mucosal spray containing tetrahydrocannabinol [THC] with or without cannabidiol [CBD]) have strong (Level 1) evidence for reducing patient-reported spasticity. These products are not available in the US, but marijuana is medically (1998) and recreationally (2014) legal in Oregon. Here we describe cannabis use in subjects in Portland, Oregon, with MS and self-reported spasticity enrolling in a randomized controlled trial of education and exercise for spasticity.

Design/Methods:
At baseline subjects report cannabis use, the route of administration, frequency of use and perceived benefits. They also reported use of prescribed medications for spasticity. Here we report data from the first 29 subjects, with an additional 40-50 subjects to be reported at the meeting.

Results:
31% (9/29) reported using cannabis. Of these, 11% (1/9) reported topical use only, all others used multiple routes of administration including topical 78% (7/9), edibles 67% (6/9), or smoking, vaping and/or tinctures 33% (3/9). All subjects reported using cannabis at least once per week: 56% (5/9) used once per day or less and 44% (4/9) used more than once per day. All subjects reported cannabis being somewhat or very helpful for pain and 78% (7/9) reported similar benefit for spasticity. 89% (8/9) reported also using a prescribed medication for spasticity, with 67% (6/9) using 10-60 mg of baclofen per day.

Conclusions:
Where both medical and recreational marijuana are legal, but pharmaceutical cannabinoids are not available and cannot be prescribed, approximately 1/3 of people with MS and spasticity report using cannabis. Most use cannabis by multiple routes of administration, find cannabis somewhat to very helpful for both spasticity and pain and are also using prescribed antispasticity medications.

[ActiveMSers]

Cannabis use by Patients with Multiple Sclerosis in Colorado

Christopher Domen et al
University of Colorado School of Medicine

Objective: To explore cannabis use among patients with multiple sclerosis (PwMS) treated at a large academic medical center in a state where cannabis is legal. Specifically, we examined: 1) prevalence of use, 2) patient characteristics of cannabis users (CUs) and non-users (NUs; e.g., demographics, disability status), 3) symptoms cannabis is used to manage, and 4) cannabis products used (e.g., combustable vs. edible).

Background: Studies suggest that cannabis may be useful for the management of symptoms like pain and muscle spasticity. However, few studies have explored the profile of PwMS who are CUs and the characteristics of their use, particularly in a state where cannabis is legal recreationally and medicinally

Design/Methods: PwMS completed a questionnaire via tablet computer assessing personal opinions about cannabis use, characteristics of cannabis use, sociodemographics, and MS history, as well as the Patient Determined Disease Steps (PDDS), Patient Reported Outcome Measure Information System (PROMIS-10), and Neuro-QoL ACGC v1.0 measures.

Results: Of 251 respondents, 38% were current CUs. No sociodemographic differences between CUs and NUs were found (p > 0.05), but CUs reported significantly higher disability compared to NUs on the PDDS (p ≤ 0.05). Among CUs, 57% categorized their use as strictly medicinal. Among strictly medicinal CUs, 91% use products that are not combusted/smoked and 83% reported using products with at least some CBD (vs. only THC). Strictly medicinal CUs also had significantly reduced self-reported physical health on the PROMIS-10 (p ≤ 0.05) and higher reported disability on the PDDS (p ≤ 0.01). CUs reported using cannabis most often to manage pain and insomnia, with 79% reporting that they experience no side-effects.

Conclusions:
Legalization efforts appear to be increasing the number of PwMS seeking out cannabis as a complimentaryalternative medicine, with CUs self-reporting that their products of choice are highly efficacious and noting minimal side-effects.